The National Institute for Health and Care Excellence (NICE) recently came out with some information about long Covid.
They have split covid into two phases – acute covid and post-acute or long covid. the former is the acute infection with the covid-19 virus which generally comprises acute respiratory symptoms (cough, fever, shortness of breath, difficulty breathing) along with other symptoms such as tiredness, muscle aches and loss of smell and taste.
This acute phase tends to last less than four weeks.
Anything beyond this may be classed as post-acute covid, however, this is also split into two separate categories:
Ongoing symptomatic covid
a) Ongoing symptomatic Covid – during which patients may still have the symptoms outlined above. This phase can last anywhere between 4-12 weeks. It is important to note that most people’s symptoms will resolve by 12 weeks.
Post-Covid 19 syndrome
b) Post-covid 19 syndrome – This is characterised by symptoms that developed during or after an infection consistent with covid-19, that persist for more than 12 weeks and are not explicable by another diagnosis.
It is reassuring that only a small minority of patients will have symptoms that persist beyond 12 weeks, but it is also important to remember that life-threatening complications can develop at any time.
Interestingly, the initial severity of disease, presence of any particular symptom in the acute phase, or even the need for hospitalisation are not indicators of whether an individual will develop long Covid. As is known those with underlying chronic health conditions are more prone to Covid-19 infections (e.g. diabetics, heart/lung disease), therefore it would follow that they are equally at risk of long Covid.
How do I know for sure if I have long Covid?
The determination of whether someone has long Covid or not, is based on clinical assessment – there is no test for it, and it is in fact a diagnosis of exclusion – which means we will only consider this when other more common factors have been ruled out. We do not know what the cause of long Covid is and should not simply dismiss someone’s symptoms as being due to that, without ruling out other potentially serious diagnoses.
Acute Covid-19 is infective, and it is during this phase that individuals can pass it on to others. The general consensus is that there will be a short (few days to a week) period during which infected individuals are asymptomatic (do not display any signs of infection) following which they may or may not become symptomatic. Currently, anyone displaying symptoms or suspected of having acute covid-19 is advised to self-isolate for 10 days once they have symptoms or a positive test. An alternative is that individuals should place themselves in quarantine for 14 days from the last exposure to a confirmed case as this relates to the maximum incubation period of the disease.
Thus, it is the acute infection that is contagious, not long Covid.
Symptoms of long COVID
There are lots of symptoms you can have after a coronavirus infection. Common long COVID symptoms include:
- extreme tiredness (fatigue)
- shortness of breath
- chest pain or tightness
- problems with memory and concentration (“brain fog”)
- difficulty sleeping (insomnia)
- heart palpitations
- pins and needles
- joint pain
- depression and anxiety
- tinnitus, earaches
- feeling sick, diarrhoea, stomach aches, loss of appetite
- a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
What should I do if I suspect I have long Covid?
If you suspect you have long Covid then you should tell your GP as there may be several things, they can do to try to help you. Whilst there is no specific treatment for long Covid, depending on what symptoms you manifest there may be a number of options available that your GP can help you with or guide you towards.
Patients can present with symptoms affecting any body system and these can fluctuate and change over time. Below is a short summary of some symptoms that individuals may experience, along with what could possibly be done for them.
Education should ideally start when a patient develops acute Covid-19. It is helpful to provide this in written format as brain fog (confusion etc) is common in Covid.
If symptoms persist >4 weeks (certainly >12 weeks) then review by the GP will be useful. Things that should be considered, include:
1. Is the diagnosis accurate (i.e. are we potentially missing something more serious)?
2. Make sure to pick up and manage any worrying symptoms – severe shortness of breath, chest pain etc. consider referral for chest x-ray or ECG.
3. Blood tests can also be arranged, looking at blood count and inflammatory markers in particular.
4. Patients can be counselled on self-management and monitoring. For example, the use of home BP machines or pulse oximeters (to keep an eye on oxygen levels) has been used quite a lot recently.
5. Simple tests like “exercise tolerance” can be advised – this a 1-minute sit to stand test where pulse, oxygen levels and breathlessness are recorded whilst the patient exercises for 1 minute.
6. For other general symptoms, patients could be referred to physios, occupational therapists (especially if they are suffering general tiredness, malaise and muscle aches).
7. Psychological referral should not be forgotten, many individuals are suffering stress, anxiety and even PTSD so referral to counsellors, talking therapies and even psychiatrists should be undertaken where it might be helpful.
The basic premise is that any persistent symptoms should warrant medical review and your doctor will assess and guide you as to the best options.
Useful resources for Covid recovery
Moving onto other common questions. The presence of Covid-19 infection (and by extension long Covid) does confer some immunity to those who have contracted it. However, it is by no means guaranteed, nor total, and cases have been seen of those who have had Covid, developing second infections some months later. It must be said that these do tend to be milder.
Once you have had covid and are not acutely unwell or have high fever and as long as more than 28 days have passed since the diagnosis, then you will be eligible for the vaccination. Hence, long Covid per se is not a preclusion from being vaccinated. The presence of antibodies post Covid is normally expected to peak around six weeks post-acute infection, therefore if you have had acute Covid you should show some antibodies in your blood. The level of antibody response is not predictable.
As far as all the evidence shows, children suffer less severely from Covid-19 infections and tend not to be so unwell. The incidence of long Covid in children is not known at the moment and it is hoped that in keeping with the less severe manifestation of acute infection, long term consequences will also be less.
The bottom line is that in order to beat this pandemic we all need to pull together. This includes healthcare workers, government officials and the general public. We all need to do what we can within our own personal capacities – from looking at medical interventions available to us, official policies that may need to be implemented and taking personal responsibility for our own actions – be that hand washing, mask-wearing or physical distancing.
If we do this then there is hope at the end of the tunnel.
Article written by Dr Suhail Hussain a private GP based in Chelsea Pharmacy Medical Clinic who also sees patients in the Greater London and Hertfordshire areas.
Dr Suhail Hussain
MBChB, MRCGP, DRCOG, DFFP, PG Dip Diabetes
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